Every finding on record at Interim Healthcare of Uniontown

Based on the findings of an onsite unannounced Medicare Recertification and State Re-licensure survey completed on December 8, 2021, Interim Healthcare of Uniontown, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Condition of Participation: Home Health Agencies-Emergency Preparedness.

Based on the findings of an onsite unannounced Medicare Recertification and State Re-licensure survey completed on December 8, 2021, Interim Healthcare of Uniontown, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical record (CR), and staff (EMP) interview, the agency failed to arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities for one (1) of seven (7) clinical records reviewed (CR6). Findings included: Review of agency policy on December 8, 2021, at 3:15pm showed, "STATEMENT OF PATIENT’S/CLIENT’S BILL OF RIGHTS...AS A PATIENT/CLIENT YOU HAVE THE RIGHT TO: ...2. receive all services outlined in your plan of care…" Review of CR6 on December 8, 2021, at 2:30pm revealed a terminal diagnosis of encephalopathy with patient receiving care from Hospice services during the day. Initial authorization 10 hours/night 7 nights/week. Physician ordered plan of care (POC) beginning 6/28/2021 for an initial certification period ending 8/26/2021. Orders included skilled nursing 10 hours/night 3 nights/week supplemental to Hospice daylight coverage. Subsequent POC dated 8/27/2021-10/25/2021 contained same orders for services. CR contained evidence of last nursing note date 8/5/2021. No evidence of any additional visits or services provided to patient. No evidence of communication with patient/family or as to inability to conduct visits. No evidence of discussion with physician of inability to staff ongoing and attempts to find appropriate services. Communication note dated 9/28/21 reported Clinical Supervisor noted obituary of patient who passed away expectedly on 9/26/21. Interview with Regional Administrator on December 8, 2021 at approximately 2:35pm revealed that initial referral came over with 10hours/night 7 nights/week, but agency was only able to staff 10 hours/night 3 nights/week and that was approved/agreed upon for start of care. Regional Administrator at this time, also reports no inability to staff hours per POC due to staff shortage which is most likely why no evidence available of visits conducted after 8/5/21. Confirms lack of evidence that there was communication/follow up with family/patient or physician. Confirms lack of documentation to support effort that appropriate transfer to an agency able to provide services was attempted. Stated, “We should have never accepted this patient if we were not certain we could staff the case.” An interview with Regional Administrator, Assistant Administrator, and Senior Regional Director of Performance Improvement on December 8, 2021, at approximately 3:30pm confirmed above findings and that agency failed to initiate appropriate transfer to appropriate services.

Treatment or care CFR(s): 484.50(e)(1)(i)(A) (i)(A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical record (CR), and staff (EMP) interview, the agency failed to consistently furnish treatment/care as ordered per plan f care for one (1) of seven (7) clinical records reviewed (CR6). Findings included: Review of agency policy on December 8, 2021, at 3:15pm showed, "STATEMENT OF PATIENT’S/CLIENT’S BILL OF RIGHTS...AS A PATIENT/CLIENT YOU HAVE THE RIGHT TO: …2. receive all services outlined in your plan of care…" “Coordination of Care/Services…Policy… Interim Healthcare maintains regular communication with the patient/client and with others providing patient/client care/services…Interim Healthcare establishes the client’s schedule to follow the plan of care/service plan…Procedure…2. The DHCS establishes processes to integrate care/services, whether provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness, the coordination of care provided by all disciplines, and communication with the physician…” Review of CR6 on December 8, 2021, at 2:30pm revealed a terminal diagnosis of encephalopathy with patient receiving care from Hospice services during the day. Initial authorization 10 hours/night 7 nights/week. Physician ordered plan of care (POC) beginning 6/28/2021 for an initial certification period ending 8/26/2021. Orders included skilled nursing 10 hours/night 3 nights/week supplemental to Hospice daylight coverage. Subsequent POC dated 8/27/2021-10/25/2021 contained same orders for services. CR contained evidence of last nursing note date 8/5/2021. No evidence of any additional visits or services provided to patient. Interview with Regional Administrator on December 8, 2021 at approximately 2:35pm revealed that initial referral came over with 10hours/night 7 nights/week, but agency was only able to staff 10 hours/night 3 nights/week and that was approved/agreed upon for start of care. Regional Administrator at this time, also reports no inability to staff hours per POC due to staff shortage which is most likely why no evidence available of visits conducted after 8/5/21. Stated, “We should have never accepted this patient if we were not certain we could staff the case.” An interview with Regional Administrator, Assistant Administrator, and Senior Regional Director of Performance Improvement on December 8, 2021, at approximately 3:30pm confirmed above findings and that agency failed to initiate appropriate transfer to appropriate services.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical record (CR), and staff (EMP) interview, the agency failed to ensure communication with physician involved in the plan of care for one (1) of seven (7) clinical records reviewed (CR6). Findings included: Review of agency policy on December 8, 2021, at 3:15pm showed, "STATEMENT OF PATIENT’S/CLIENT’S BILL OF RIGHTS...AS A PATIENT/CLIENT YOU HAVE THE RIGHT TO: …2. receive all services outlined in your plan of care…" “Coordination of Care/Services…Policy… Interim Healthcare maintains regular communication with the patient/client and with others providing patient/client care/services…Interim Healthcare establishes the client’s schedule to follow the plan of care/service plan…Procedure…2. The DHCS establishes processes to integrate care/services, whether provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness, the coordination of care provided by all disciplines, and communication with the physician…” Review of CR6 on December 8, 2021, at 2:30pm revealed a terminal diagnosis of encephalopathy with patient receiving care from Hospice services during the day. Initial authorization 10 hours/night 7 nights/week. Physician ordered plan of care (POC) beginning 6/28/2021 for an initial certification period ending 8/26/2021. Orders included skilled nursing 10 hours/night 3 nights/week. Subsequent POC dated 8/27/2021-10/25/2021 contained same orders for services. CR contained evidence of last nursing note date 8/5/2021. No evidence of any additional visits or services provided to patient. No evidence of discussion with physician of inability to staff ongoing and attempts to find appropriate services. Communication note dated 9/28/21 reported Clinical Supervisor noted obituary of patient who passed away expectedly on 9/26/21. Interview with Regional Administrator on December 8, 2021 at approximately 2:35pm revealed that initial referral came over with 10hours/night 7 nights/week, but agency was only able to staff 10 hours/night 3 nights/week and that was approved/agreed upon for start of care. Regional Administrator at this time, also reports no inability to staff hours per POC due to staff shortage which is most likely why no evidence available of visits conducted after 8/5/21. Confirms lack of evidence that there was communication/follow up with family/patient or physician. Confirms lack of documentation to support effort that appropriate transfer to an agency able to provide services was attempted. Stated, “We should have never accepted this patient if we were not certain we could staff the case.” An interview with Regional Administrator, Assistant Administrator, and Senior Regional Director of Performance Improvement on December 8, 2021, at approximately 3:30pm confirmed above findings and that agency failed to initiate appropriate transfer to appropriate services.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical record (CR), and staff (EMP) interview, the agency failed to provide services per the plan of care for one (1) of seven (7) clinical records reviewed (CR6). Findings included: Review of agency policy on December 8, 2021, at 3:15pm showed, "STATEMENT OF PATIENT’S/CLIENT’S BILL OF RIGHTS...AS A PATIENT/CLIENT YOU HAVE THE RIGHT TO: …2. receive all services outlined in your plan of care…" “Coordination of Care/Services…Policy… Interim Healthcare maintains regular communication with the patient/client and with others providing patient/client care/services…Interim Healthcare establishes the client’s schedule to follow the plan of care/service plan…Procedure…2. The DHCS establishes processes to integrate care/services, whether provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness, the coordination of care provided by all disciplines, and communication with the physician…” Review of CR6 on December 8, 2021, at 2:30pm revealed a terminal diagnosis of encephalopathy with patient receiving care from Hospice services during the day. Initial authorization 10 hours/night 7 nights/week. Physician ordered plan of care (POC) beginning 6/28/2021 for an initial certification period ending 8/26/2021. Orders included skilled nursing 10 hours/night 3 nights/week. Subsequent POC dated 8/27/2021-10/25/2021 contained same orders for services. CR contained evidence of last nursing note date 8/5/2021. No evidence of any additional visits or services provided to patient. Communication note dated 9/28/21 reported Clinical Supervisor noted obituary of patient who passed away expectedly on 9/26/21. Interview with Regional Administrator on December 8, 2021 at approximately 2:35pm revealed that initial referral came over with 10hours/night 7 nights/week, but agency was only able to staff 10 hours/night 3 nights/week and that was approved/agreed upon for start of care. Regional Administrator at this time, also reports no inability to staff hours per POC due to staff shortage which is most likely why no evidence available of visits conducted after 8/5/21. Confirms lack of evidence that there was communication/follow up with family/patient or physician. Confirms lack of documentation to support effort that appropriate transfer to an agency able to provide services was attempted. States, “We should have never accepted this patient if we were not certain we could staff the case.” An interview with Regional Administrator, Assistant Administrator, and Senior Regional Director of Performance Improvement on December 8, 2021, at approximately 3:30pm confirmed above findings and that agency failed to initiate appropriate transfer to appropriate services.

Based on the findings of an unannounced onsite Complaint Investigation Survey completed on September 14, 2021, Interim Healthcare of Uniontown, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Mistreatment, neglect or abuse CFR(s): 484.50(e)(1)(i)(B) (i)(B) Mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and/or misappropriation of patient property by anyone furnishing services on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on review of Department of Health (DOH) Event Reporting System (ERS), agency policy/procedure, complaint log, clinical records (CR) and personnel files (PF) and staff (EMP) interviews, the agency failed to investigate complaints related to mistreatment, neglect, and/or physical abuse, including injuries of unknown source by anyone furnishing services on behalf of the Home Health Agency in accordance with agency policy/procedure for one (1) of one (1) CF reviewed involving patient injury (CF1.) Findings included: Review of DOH ERS on 9/2/2021at approximately 12:30 pm revealed an event report dated 8/12/21 that documented that on 8/9/21 at 11:30 am HHA (home health aide) was changing patient and when "...home health aide went to fasten diaper, [HHA] heard a "snap" sound. Client screaming and crying...Client diagnosed with right femur fracture..." Review of agency complaint log on 9/14/21 at approximately 12:50 pm revealed: Occurrence dated 8/9/21 on complaint log. "Resolution Details: Client went to Children's Hospital and they diagnosed with broken right femur. Client discharged 8/10/21 with spica cast. Child Youth Services (CYS) involved due to severity of break. CYS is investigating employee. Employee was removed from all scheduling until results from investigation are received. Explanation: Send CYS all documentation requested on 9/8/21." Review of agency policy/procedure on 9/14/21 at approximately 1:00 pm revealed: "...Occurrences and Sentinel Events, Policy...Interim HealthCare Employees report as a sentinel event any unexpected occurrence involving a patient/client that results in unexpected death or serious physical or psychological injury or risk for such, Interim HealthCare analyzes reported occurrences and sentinel events, and takes appropriate action...Procedure...5. Upon receipt of a report of an occurrence or sentinel event, the Administrator/Manager or designee documents the report-including the date of the report and the reported nature of the occurrence or sentinel event...6. The Administrator/Manager or designee contacts the employee most familiar with the occurrence or sentinel event and he/she documents the reported facts of the occurrence in the patient/client record including any physician or allowed practitioner contact...7. The Administrator/Manager or designee ensures the responsible family members or other caregivers are advised of the occurrence. 8. Any additional action taken by the Administrator/Manager or designee that is not related to patient/client care/service with the exception of any employee action which is documented in the employee file...10. The Administrator/Manager or designee: a) establishes the circumstances of the occurrence...b) Conducts a root cause analysis of a sentinel event...c) Reports the findings of the investigation to their risk manager...d) Maintains the documentation of the circumstances or root cause analysis in the quality improvement files. 11. The Administrator/Manager or designee communicates any occurrences and sentinel events as well as result of any root cause analysis to the governing body/owner." CR1, start of service (SOS) 3/24/21, reviewed on September 14, 2021 at approximately 1:45pm. Review of time period 7/22/21-9/14/21. 8/11/21 entry into patient record by nurse outlines email from patient's parent after hospital discharge confirming right femur fracture. PF1, date of hire (DOH) 3/16/21, reviewed on 9/14/21 at approximately 11:00 am contained note entered by the supervising nurse on 8/26/21 at 9:42 am stating that on 8/9/21 at 1:00 pm, "Employee called into office crying, speech unclear, tried to verbalize that she thought she broke client's leg on accident during a diaper change..." Note entered by the supervising nurse on 8/26/21 at 9:50 am stated that on 8/11/21 at 12:00 pm, "Spoke to employee via phone about event that happened 8/9/21 after hearing from mother after hospital discharge. Employee stating [employee]was changing [patient's] diaper, at this time client was fussy and kicking legs. As [employee] went to fasten [patient's] diaper [employee] heard a "snap" sound. Client kicking and screaming and crying..." Agency unable to provide documentation of internal investigation of complaint of patient injury incurred while receiving care. No evidence available that agency followed policy to investigate, document or report occurrence. Documents required by agency policy not available for review include: Administrator/Manager report, involved employee reported facts of the occurrence in the patient/client record including any physician or allowed practitioner contact, Administrator/Manager contact with family members or other caregivers, any additional action taken by the Administrator/Manager that is not related to patient/client care/service, employee action documented in the employee file, Administrator/Manager established circumstances of the occurrence, root cause analysis of a sentinel event, findings of the investigation reported to risk manager, maintained documentation of the circumstances or root cause analysis in the quality improvement files, communication of occurrences/sentinel events as well as result of any root cause analysis to the governing body/owner. Exit Interview conducted on September 14, 2021 at approximately 4:30 pm with Regional Administrator, Senior Regional Director, and Home Care Supervisor confirmed findings.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of Department of Health (DOH) Event Reporting System (ERS), clinical records (CR) and staff (EMP) interviews, the agency failed to promptly alert the relevant physician to any changes in the patient's condition or needs for one (1) of three (3) CRs reviewed (CR1.) Findings included: Review of DOH ERS on 9/2/2021at approximately 12:30 pm revealed an event report dated 8/12/21 that documented that on 8/9/21 at 11:30 am HHA (home health aide) was changing patient and when "...home health aide went to fasten diaper, [HHA] heard a "snap" sound. Client screaming and crying...Client diagnosed with right femur fracture..." CR1, start of service (SOS) 3/24/21, reviewed on September 14, 2021 at approximately 1:45pm. Review of time period 7/22/21-9/14/21 failed to include evidence that the patient's plan of care physician, or any additional treating providers were notified of patient injury sustained at visit or of any information post hospital discharge. 8/11/21 entry into patient record by nurse outlines email from patient's parent after hospital discharge confirming right femur fracture. Interview conducted on September 14, 2021 at approximately 2:00 pm with Regional Administrator confirmed that any abnormal observations should be documented and reported to the nurse managing the case and to the patient physician. Administrator unable to locate documentation and stated, "it should be done, but there is not documentation that it was."

Home health aide qualifications CFR(s): 484.80(a) Standard: Home health aide qualifications. This STANDARD is not met as evidenced by: Based on review of agency policy/procedure, personnel files (PF), and staff (EMP) interviews, the agency failed to follow agency policy for orientation of Home Health Aides for two (2) of three (3) PF reviewed (PF2&3.) Findings included: Review of agency policy/procedure on 9/14/21 at approximately 1:00 pm revealed: "...Assessment and Documentation of Competency...Employees are not assigned to provide patient care/client services whose competency has not been determined...Purpose, To provide safe and effective care/service to patients/clients...Assessment of Competency Prior to Assignment...b) Reviewing the employee's previous experience and current level of self-assessed independence by ensuring that each employee who provides care/service completes the appropriate Home Care Skills Evaluation & Experience Checklist related to their job responsibility prior to assignment...c) requiring employees to demonstrate the following skills on a patient or pseudo patient as part of a simulation prior to any assignment requiring these skills: i) Any skill rated by the employee on their skills checklist as no experience, requires supervision or needs training; ii) Any skill identified on their skills checklist as requiring demonstration/verbalization...4)The DHCS or designee documents the results of the skills demonstration on the applicable skills inventory checklist and files such in employees file..." Review of agency documents part of PF review on 9/14/21 at approximately 1:15 pm revealed: Skills Checklist-Home Health Aide, as per guidance for employee completion: 0=no experience 1=knowledgeable with limited experience. Requires additional training/supervision 2=Knowledgeable and experienced. Can perform without supervision Review of PF2 on 9/14/21 at approximately 1:20 pm revealed employee date of hire (DOH) 3/30/21. PF revealed self-evaluation skills checklist submitted 4/12/21. Employee documentation reflects "0" in the following categories: Care of a Patient-Paraplegic, Quadriplegic, and Psychiatric disorder. Employee documentation reflects "1" in the following categories: Care of a Patient-Geriatrics, Alzheimer's disease, and Stroke. Mandated/Required Skills- taking/reading/recording pulse, taking/reading/recording respirations, bed bath, sponge bath, tub bath, shower bath, hair shampoo in sink, hair shampoo in tub, hair shampoo in bed, nail care, skin care, oral hygiene, ambulation, transfer techniques, range of motion exercises, positioning, assisting with toileting and elimination. Other Skills- taking/reading/recording B/P, making occupied bed, foley catheter care, using a Hoyer lift, using a gait/transfer belt, using a wheelchair, weighing a patient. Infection Prevention Control- Use of standard precautions and equipment /supply bag technique. PF failed to include documentation of follow up training or supervision for skills documented as a "1" or "0" on self-evaluation, per agency policy. Review of PF3 on 9/14/21 at approximately 1:30 pm revealed employee DOH 5/18/21. PF revealed self-evaluation skills checklist submitted 6/1/21. Employee documentation reflects "0" in the following categories: Care of a Patient-Quadriplegic. Employee documentation reflects "1" in the following categories: Care of a Patient-Pediatrics: Infant/toddler/pre-school/school age and Paraplegic. Other Skills- using a gait/transfer belt. PF failed to include documentation of follow up training or supervision for skills documented as a "1" or "0" on self-evaluation, per agency policy. Exit Interview conducted on September 14, 2021 at approximately 4:30 pm with Regional Administrator, Senior Regional Director, and Home Care Supervisor confirmed findings.

If concern identified, direct observation CFR(s): 484.80(h)(1)(ii) If an area of concern in aide services is noted by the supervising registered nurse or other appropriate skilled professional, then the supervising individual must make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while he or she is performing care. This ELEMENT is not met as evidenced by: Based on review of Department of Health (DOH) Event Reporting System (ERS), agency policy/procedure, clinical records (CR), personnel files (PF) and staff (EMP) interviews, the agency failed to ensure that after an injury the supervising registered nurse made an on-site visit in order to observe and assess the aide performing care in accordance with agency policy for one (1) of one (1) PF reviewed involved in patient injury. (PF1.) Findings included: Review of DOH ERS on 9/2/2021at approximately 12:30 pm revealed that an event report dated 8/12/21 documented that on 8/9/21 at 11:30 am HHA (home health aide) was changing patient and when "...home health aide went to fasten diaper, [HHA] heard a "snap" sound. Client screaming and crying...Client diagnosed with right femur fracture..." Review of agency policy/procedure on 9/14/21 at approximately 1:00 pm revealed, "...Supervision of Employees Who Provides Patient/Client Care/Services...Policy...Designated supervisors conduct employee supervision in at least the following situations ' ) ...injuries involving an employee is identified...Home Health Aides or Personal Care Aides...2. The designated supervisor conducts employee supervision while the employee is providing care/service.3. The following items are addressed during the supervision of the Home Health Aide...f) Demonstrating basic skills or supplemental or delegated tasks necessary for delivery of assigned service. 4.) The designated supervisor: a.) Documents the results of the supervision of the employee...b) Observes the demonstration of the skill(s) and documents the results...c) Reviews the findings of the supervision with the employee, and takes action as appropriate...d) Ensues the timely filing of the completed Employee supervision Report form..." CR1, start of service (SOS) 3/24/21, reviewed on September 14, 2021 at approximately 1:45pm. Review of time period 7/22/21-9/14/21. 8/11/21 entry into patient record by nurse outlines email from patient's parent after hospital discharge confirming right femur fracture. PF1, date of hire (DOH) 3/16/21, reviewed on 9/14/21 at approximately 11:00 am contained note entered by the supervising nurse on 8/26/21 at 9:42 am stating that on 8/9/21 at 1:00 pm, "Employee called into office crying, speech unclear, tried to verbalize that she thought she broke client's leg on accident during a diaper change..." Note entered by the supervising nurse on 8/26/21 at 9:50 am stated that on 8/11/21 at 12:00 pm, "Spoke to employee via phone about event that happened 8/9/21 after hearing from mother after hospital discharge..." PF failed to contain evidence that supervision was conducted with employee post patient injury involving employee. PF failed to contain documentation that supervisor observed the demonstration of the skills, documented the results, reviewed the findings of the supervision with the employee, or ensured timely filing of the completed Employee supervision Report form. Exit Interview conducted on September 14, 2021 at approximately 4:30pm with Regional Administrator, Senior Regional Director, and Home Care Supervisor confirmed findings.